Saturday, 20 April 2013

"That" Person

Despite my best efforts, I have become "that" person.

1.The person who is always late - despite high levels of family organisation somehow life seems to conspires against me, and I increasingly frequently end up being late.  Either someone needs an extended toilet trip, someone else has lost something, remembered something, the phone rings as we are leaving... the list is endless. I really value good timekeeping and punctuality in others and I used to pride myself on always being on time, usually early - but that was with the smug certainty of having only one person to get out of the door. Myself.

Persuading and organising four children is at the best of times akin to herding cats. (I have three of those too and they frequently present a significant challenge not dissimilar to the children.) I am pretty convinced there is an ongoing conspiracy between children and animals in this house and they collectively share the responsibility of vomiting on the floor, needing the toilet, requiring food or precipitating some other emergency which makes me late. Again. I suspect mother now automatically adds an extra half an hour to any estimated time of arrival I give her these days but is too nice to tell me!

2.The person apologising for missing that all-important school letter, the reply slip for which was supposed to be in last week. Or better still, you DID send the slip in... but completely forgot to enter the relevant details on the calendar. We've had some close shaves lately, when I have bluffed my way through a conversation with one or other school, frantically rummaging through my brain for the missing information which should have been to hand. Gone are the days of the feeling of satisfaction when your diary includes everything the children are doing with annotated notes on the day's requirements beside each event.

3.The person who backs out at the last minute - this is one I find really painful to admit. Like punctuality, reliability has a phenomenal level of value to me. Yet here I am, doing exactly what I dislike having done to me. Letting people down at the last minute.

Of course there is always a good reason, and I am certain the same is true for everyone else. And having four children with quite a flabbergasting number of hospital appointments has quite an impact on the odds of me meeting my commitments even when life is on an even keel. But throw the proverbial spanner in the works - a child in hospital, off school or a string of emergency meetings and any chance of normality flies out of the window, a State of Emergency is declared and anything beyond school and meals has but a slim chance of occurring. Which brings me on to the next person:-

4.The person who operates on a crisis management basis, reactive rather than proactive. You know, the person who dashes in last minute, (late, see 1.) having forgotten something vital (see 2.) looking flustered and panicky. That's often me - and yet it isn't. I am a control freak. I admit it. But battling the chaos of reality in a war I cannot win is something I struggle to come to terms with. You cannot function at your best in reactionary mode, at least not if your forte is ├╝ber levels of organisation with the task nailed before you leave home.

But maybe I'm missing something? Because actually, whilst on one level I deplore lateness, being let down, disorganisation and crisis management, there is no escaping the chaos which infects the lives of big families with or without the addition of considerable health needs. There is definitely a level of satisfaction and even exhilaration from "winging it" and getting by. Just. It wouldn't be my choice of modus operandi but I don't have that choice. So for now I will embrace my inner "person" and continue to fly by the seat of my pants... ensuring the fridge has a bottle of Pinot Grigio chilling come Friday evening!

Monday, 8 April 2013

Maggie Thatcher - RIP

I have been quite astounded and shocked by the many appalling things written on social media today as people heard about the death of Baroness Margaret Thatcher.  Not because I am naive enough to think she was always right, nor that her policies did not impact unequally on the electorate. But what stronger evidence could we have of the manipulation of popular opinion by the gutter press than the outcry which went up today.

Many of the posts I have read are from those who were not even alive when she was Prime Minister, who have no first hand experience of life in the 1970s with the plethora of strikes and the 3 day week, with dead bodies rotting in the sun with no one to bury them, the water strikes, the power outages, and the National Debt. People forget we went to the IMF cap in hand for a $4 billion bail out in the 70s and she not only paid off the massive sum but in 1997 the outgoing Conservative government left a £20 billion surplus for Tony Blair on leaving Office - £40 billion more than Brown's government had in the bank by 2008.

When Margaret Thatcher became Prime Minister in 1979 the top rate of tax was 83%; by the time she left it was 40%. During the 1970 high earners left the country, the infamous "Brain Drain" and our economy suffered. Under her aegis government spending dropped from 42.7% of GDP to 39.2% of GDP (though it actually rose for much of the 80s, and health spending never really fell). We were were also still paying off a debt to the USA when Thatcher came to power, it was offered as help in the post World War 2 period when Britain was essentially bankrupt- payments for which were sometimes suspended if the exchange rate were significantly disadvantageous. (since the loan was linked to the convertability of sterling) Under Thatcher our pound strengthened, payments were no longer missed and this added to improved relations with the USA.

Britain regained considerable national standing in Europe under Thatcher who negotiated the British rebate saying "We are simply asking to have our own money back." She was a formidable character on the International stage and Britain was a  strong advocate of the Single Market. However she never envisaged giving up a degree of national sovereignty which was a corollary to this. In her keynote speech on Europe, delivered in Bruges in September 1988, she said: "We have not successfully rolled back the frontiers of the state in Britain, only to see them re-imposed at a European level with a European super-state exercising new dominance from Brussels." I am very against "Big Government" as I have said before, and I fully support the ethos of a single market but feel - as do many many others - that the European Union has gone too far, and some of Thatcher's fears were not so wide of the mark. Maybe she was just braver than the rest of us and voiced what others felt unable to do? She was, in her own words, a "Conviction Politician" and they are a rare breed. Far more credible and with greater integrity than the "Convenience Politician"of today, who nurtures a short termist approach to politics with his or her eye fixed almost solely on the next election. Thatcher was ambitious, yes, but had a vision.

Sunday, 7 April 2013

Do you enjoy reading my Blog?

If so, please nominate me for the Brit Mums "Writer" award :)

Friday, 5 April 2013

The end of the NHS? CCGs - Power to the People?

There have been many articles, headlines (I'm thinking The Independent, Cover story 2nd April) and Blog posts deploring the end of the NHS with the Health and Social Care Act which this week become Law. Our local newspaper had a large NHS advertisement published on the same day entitled "Shutdown of NHS Suffolk", likely to have scared the living daylights out of a large percentage of its readership. I even found myself succumbing to the inner panic such propaganda aimed to ignite, fearing an end to the healthcare my children currently rely on. So widespread has the panic been that surely it *had* to be the beginning of the end of our NHS?

My biggest fear was that encouraging GPs to commission services was an ideal about forty years out of date. What practice has a stable and unchanging group of GPs these days? Every time I visit our surgery there has been a turnover of approximately a third of the GPs, some of them only GP Registrars. Long gone are the days of a "Family Doctor", a local GP who knows his or her caseload and looks after families for years, getting to know them and their needs. Just HOW are an ever-changing group of professionals, several only locums, going to have any inkling as to what services may be required in a particular area? It might have worked beautifully in bygone days, when the NHS was in its infancy and demand was substantially lower but I was slightly alarmed at the premise that today's society could support such change.

I am however a true Liberal, in the old sense of the world. I abhor Big Government, prefer self determination and am rather scathing of men in suits with little or no experience of my life making decisions which impact on me at every turn. Any semblance of decentralisation was bound to grab my interest.

So I took my head out of the sand, and decided to read. I'm barely past the first few pages but I am already feeling considerable reassured. Take Ipswich and East Suffolk. I visited our GP Clinical Commissioning Group page, and clued myself up.... breathing a huge sigh of relief. Here at least, I can see this revolutionary overhaul might just actually work. On the Clinical Executive, and the Governing Body, were names I recognised. People I knew. Most importantly professionals I respect and admire. GPs who are senior partners at the best practices in our area. There are two or three extremely successful large medical centres in our CCG. These have bought in services to support their community which have taken considerable pressure off local hospitals (ECGs done at Hadleigh for example) and speeded up routine testing. The Senior Partners for these Centres are now involved in making the new system work, and after 14 years watching at least two of them have such positive impacts on their own surgeries I am considerably more enthusiastic.

The best "bit" of the new changes, which really are revolutionary, is that the Men in Suits are almost obsolete. Politicians and Civil Servants now have less say in local healthcare, which is in the hands of the health professionals. I'm not sure there is an ideal, but I certainly wish someone had a similar idea for Education. How many teachers are sick and tired of being dictated to by Westminster and Whitehall? Politicians and Civil Servants Hell bent on "making their mark" in a Department they will have four years in at best, and in an area they have little expertise. I totally support the concept at least of devolving power to local areas to commission healthcare as they see fit. Obviously you don't want to subdivide areas into such tiny blocks that their bargaining power is reduced to little more than a whisper, but cutting out the middle man so to speak, or reducing his influence has to be a good thing. Too much money is wasted on management within the NHS and almost every area of the public sector. It's not only saving money (hopefully!) it's placing the purse strings and decision making in the hands of the professionals.

The cynic in me doubts it can be accomplished without a variety or problems, not least the apparent incompetence of almost every government in history to effect such sweeping change without making a few catastrophic miscalculations. I and the rest of the country live in hope this isn't one - and reading between the lines I suspect the Labour party actually wish this too. Overturning such a far reaching Act would be politically, financially and practically  challenge of enormous magnitude.

My biggest current concern is over data sharing, resolving the current mostly appalling communication lines between primary, secondary and tertiary care. Between community and hospital professionals, and above all from and to GPs. Hospitals like Great Ormond Street get their clinic letters typed in India - and some of ours have been sent to Ipswich Australia when a well intentioned typist googled "Ipswich Hospital"! Excellent communication is vital, it's the key which will make or break this new system. Because if GPs are not aware of 100% of a patient's healthcare they will NOT be best placed to commission appropriate services.

So I hold my breath and wait, and watch. I sincerely hope this is the major step forward it has been flagged up to be - because the NHS certainly needs to evolve from the elephant wading through custard   experience most of its users have.
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